0310-253 (RPL)H
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my:icense is in full force and effect.
License# *° Lic. Class Exp. Date
61,1611 CJ ,/� 9r3ClC?s
Date �+�� °+-- Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, -or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals:.
Code).
() I am exempt under Section B&P.C. for this reason
Date SirgnatUre of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no: are:
Carrier l)k'i•.,°iC ►1%1' Policy No. tC�i:�II0339SA
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: d... Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to -$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton_agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read'fhis application and state that the above information is
correct. I agree to comply,with all City, and State laws relating to the building
construction, and hereby authorize representatives of.,this City to enter upon
the above-mentioned property for inspection purposes.
Signature' {'Owner/Agent) ,� ='� .� �'" Date • : !�•5
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE Y54..,
APN
ADDRESS K -1110 -
ti
OWNER CONTRACTOR /DESIGNER/ EN INEER
M) WINNUMV-1 :►'tl.C° i'T T;ow z a > P.A-s
81;.170 GOIT V 170,1.DAUV P.O. B0_ X 1791
Lai (JT la-7FA CA 912233 111 Qi7WT %6 ^A
�'d60�34r•3s s CXX
I USE OF PERMIT
:PCs07./ ,3NVOR W? -1
I?; QLAZIRA.. ,M..Atf?MtVIMRR, i8R, l+PI.,P.CZATPRE'-'iJiS'i R.
I11 .r' WIR4441' N���'TJF.Z 110T WCU�EDr"11GH. 4
POOL. MINOR fi� A.
19,0 up La
1r~ii-rat<tmm) %C?l T OF commucKri1,r
1 KI"Te r' FYX sub-s"Ry
PLAN CHECK FEEl'
4;�„')�,,t�39�31 �
Sf.C:�.,:
CONSTRUCTIONE,
'101 -.000-w• 18-00.0
$bi t`}i AV,IC-&L FEE,, POOL
01--.'1010,,421 •(.I'tW.
ELEX,'TRIC.',A,L'srf? Z • • POOL
101..009420-00:0
Px,�t11�1�1'l�T� •.';x:01.•'?1,�a1?�i1•t3t3t�
NOV. 1
CITY OF I.t:
FINANOE
SUB..2(7'. , CIONs?Z1.T.M'r1,GA-f A91)1 1,414 C. lT..0:K: 3 3.30
U0,0 iRE- PAJ Mu
IXAJ�L FERNOTTMES DUE WW"
a
RECEIPT J DATE ,t y BY ATE F INSP R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel'
Combustion Air
Roof Deck
Exhaust Fans
O.K=toWrap
Fraffltg
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location JAL
Underground Electric
Underground Plbg. Test
Final "
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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2003/OCT/22/WED 02:48 PM
September 30, 2003
MONARCH ACCOUNTING FAX No,760 776 5112
�I�1�1lM1
FAIRWAYS ASSOCIATION
Mr. & Mrs. Ted Winnowsld
11333 SW Northgatd Avenue
Portland OR 97219
RE: 81-170 Golf View Drive
Dear Mr. & Mrs. Winnowsld:
P. 001/001
At the September 16, 2003 Architectural/Landscape committee meeting the plans you submitted
were reviewed. The committee will do a final review of your application after submittal of the
following:
1. The exact measurement from the property line to the pool wall is needed.
2. An 18" to 24" concrete mow strip must be installed behind the pool wall.
3. An easement agreement from KSL is required.
Note: Approval of your landscape and/or pool plans by the Architectural/Landscape Committee
does NOT include any right of access by your contractor to your lot through the golf course. To
request permission to access your lot through the golf course, please contact the legal department
at KSL Desert Resorts (760-564-8023) regarding a temporary access license. Access without
written permission could be deemed criminal trespass.
If you have any questions or wish to discuss this please give me a call.
Sincerely,
Nancy Duane, CCAM
Association Manager
ND/ncp
October 22, 2003
All of tb a above co�tions .have been met and you are authorized to proceed.
Nancy Duan i6,'%ssociation Manager
Post Office Box 1658 - La Quinta, California 92253 • Phone (760) 564-3858 - Fax (760) 564-2329